Type 2 diabetes – what are the warning signs, and how can I reduce my risk?

From restless.co.uk

Diabetes is a major health challenge in the UK, affecting more than 5.8 million people. While type 2 diabetes accounts for roughly 90% of diagnosed cases, Diabetes UK warns that up to 1.3 million additional people may have the condition without knowing it.

Uncontrolled diabetes can come with serious complications – such as eye problems, nerve damage, and an increased risk of heart attack or stroke. So it’s important that it doesn’t go unchecked and untreated.

While this may sound daunting, try to remember that diabetes is usually manageable. Many people live long and healthy lives if the condition is handled properly. There are also several things that can prevent, and even reverse, its development.

Here, we’ll take a closer look at what type 2 diabetes is, the warning signs, and how you can reduce your risk.

What is type 2 diabetes?

Type 2 diabetes is a condition that most commonly occurs in people over 40. Those with the condition either don’t produce enough insulin or their bodies become resistant to it, preventing it from working effectively.

Insulin is a hormone that’s made in the pancreas. It acts like a key, allowing the carbohydrates we get from food and drink (which are broken down into glucose) to enter our cells, where they can be used as energy or stored as fat.

When insulin isn’t being used by the body properly, blood sugar levels can become too high (hyperglycemia). Levels that remain high can damage blood vessels and lead to health complications, with the heart, eyes, feet, and kidneys affected most often.

Type 2 diabetes differs from type 1 diabetes, which is usually caused by an autoimmune reaction where the body mistakenly attacks itself, destroying the cells in the pancreas that make insulin. Type 1 diabetes often runs in families and is usually diagnosed before the age of 40.

What are the warning signs of type 2 diabetes?

Symptoms of type 2 diabetes might not always make you feel unwell, which is why many people can live with it for many years without realising.

However, according to health experts, if you have type 2 diabetes, you might find that you…

• Urinate more frequently, especially at night
• Struggle to satisfy your thirst, or feel thirsty all the time
• Have a dry mouth

• Feel more tired than usual

• Lose weight without trying to

• Experience blurred vision
• Take longer to heal after a cut
• Get regular bouts of thrush and/or itching in your penis or vagina

• Experience nerve pain, numbness, or tingling in your hands and/or feet

• Have dark patches on your armpits, neck, and groin areas (this is known as acanthosis nigricans and can be caused by excess insulin in the blood)

It’s important to visit your GP if you’re experiencing any of these symptoms, as the earlier diabetes is diagnosed and controlled, the lower your risk of developing long-term health complications.

Health complications of type 2 diabetes can include…

• Diabetic neuropathy (nerve damage)
• Heart attack and stroke due to damaged blood vessels

• Foot problems, such as ulcers and infections, due to poor circulation and nerve damage

• Kidney damage and/or disease (nephropathy)

• Gum disease (more sugar in your blood means more sugar in your saliva)
• The development of certain cancers

• Sexual problems due to restricted blood flow to the sexual organs

• Eye problems due to damage to the eye’s blood vessels (retinopathy)

To learn more about the health complications of type 2 diabetes, it’s worth reading this page from Diabetes UK.

How is type 2 diabetes diagnosed?

Type 2 diabetes can be easily diagnosed with a blood or urine test, which can be administered at your GP surgery or local health centre. Alternatively, you can pay a fee to do a test at home using an online service, such as Thriva.

Once you post off your sample, you should receive your results and a doctor’s report within 48 hours. If your blood sugar levels are raised, you’ll be advised to discuss the results with your GP.

If you have diabetes, your GP will talk to you about the best ways to control it, which usually involves medication, insulin therapy, and/or lifestyle adjustments.

You’ll also be required to monitor your blood sugar levels at home and attend regular check-ups with a doctor or nurse to make sure everything is under control.

To find out more about what happens after a type 2 diabetes diagnosis, head over to the NHS website. Or, if you’ve recently been diagnosed, you may find this page from Diabetes UK helpful.

What is prediabetes?

If your blood test tells you that your blood sugar levels are high but not high enough for a type 2 diabetes diagnosis, you might be told you have ‘prediabetes’ or ‘borderline diabetes’.

Prediabetes is an important stage in the development of diabetes, and by making some lifestyle adjustments, it’s possible to lower blood sugar levels and prevent it from progressing to type 2 diabetes.

To learn more about high blood sugar levels, have a read of this advice from the NHS.

However, it’s important to note that blood sugar levels can be interpreted differently based on a person’s individual circumstances. Your doctor will be able to confirm what your blood sugar levels should be.

Could I be at risk of developing type 2 diabetes?

As well as looking out for warning signs of type 2 diabetes, it’s important to know your risk, so you can be proactive in taking control of your lifestyle.

According to Diabetes UK, your risk of developing type 2 diabetes increases if you…

• Are overweight or obese (particularly if you carry a lot of extra weight around your midsection). Obesity is thought to account for 80-85% of the risk of developing type 2 diabetes.
• Are white and over the age of 40, or Black African, African-Caribbean, or South Asian and over the age of 25.

• Are a man (diabetes is slightly more common in men than women).

• Have a parent, sister, brother, or child with diabetes (two to six times more likely).
• Have Black African, African-Caribbean, or South Asian heritage (two to four times more likely).
• Have a history of high blood pressure.

If you’d like to find out your risk of developing type 2 diabetes, you can do so in just a few minutes using this tool on the Diabetes UK website. You’ll need to know your height, weight, and waist size before you get started.

Find out my risk

How can I reduce my risk of developing type 2 diabetes?

It’s estimated that there are over 13.6 million people with an increased risk of developing type 2 diabetes in the UK today.

However, if you think you’re at risk, there are ways to reduce it. In fact, Diabetes UK has highlighted that getting help from your GP can help cut your risk of type 2 diabetes in half.

The main ways to reduce your risk of developing type 2 diabetes are…

1. Make positive changes to your diet

While it might seem obvious, eating a healthy, balanced diet is one of the best things you can do to maintain a healthy weight and improve your overall health.

Small but beneficial steps you can take include…

Reducing your intake of simple sugars and refined carbohydrates

High intake of simple sugars and refined carbohydrates can contribute to weight gain. Simple sugars are also rapidly turned into glucose and absorbed into the bloodstream, causing blood sugar levels to rise quickly.

One of the best ways to reduce your intake of simple sugars and refined carbs is to limit processed foods in your diet (as they’re often high in fat, sugar, and empty calories) and eat more whole foods.

If you have a sweet tooth and would like tips on how to reduce your sugar intake, it’s worth reading our article: 9 simple ways to cut back on added sugar.

Eating smaller, more frequent meals

Eating smaller, more frequent meals can help regulate blood sugar levels.

A study of prediabetic men found that those who ate smaller portion sizes and adopted other healthy nutritional changes were 46% less likely to develop diabetes than men who made no changes to their eating habits.

For suggested portion sizes, check out this advice from The Association of UK Dietitians. Our article, 9 tips to prevent overeating and encourage portion control, also has some helpful tips.

Drinking more water

Staying hydrated helps your body remove excess glucose through urine. The NHS recommends drinking six to eight cups of fluid a day, with water being a top choice.

If you’re struggling to increase your water intake, you could consider investing in a water bottle with time markings* as a reminder to drink throughout the day.

Our articles, 10 tips for staying hydrated and 9 healthy and hydrating alternatives to water, offer more ideas.

Following a low-carb diet

Following a low-carb diet can be effective at keeping blood sugar levels low and stable because carbohydrates raise them more than any other food group.

Check out our article, 8 tasty and filling low-carb meals, for inspiration.

Eating more fibre

Increasing your fibre intake can help you maintain a healthy weight, reduce blood cholesterol levels, and improve gut health.

The government advises that adults should eat 30g of fibre a day – yet most people eat far less.

For tips on increasing your fibre intake, take a look at our article: 10 easy ways to add more fibre to your diet.

Getting enough vitamin D

Studies have shown that vitamin D can help lower blood sugar levels and decrease the risk of type 2 diabetes.

To make sure you’re getting enough, check out our article: What is vitamin D and why do we need it to stay healthy?

Cutting down on alcohol

Heavy drinking can interfere with blood sugar control and lead to weight gain, which can increase type 2 diabetes risk.

Diabetes UK advises that the safest way to enjoy a drink and keep your risk of developing type 2 diabetes to a minimum is to stick to the NHS alcohol guidelines.

You’ll find plenty more healthy diet tips in our diet and nutrition section.

2. Be more active

Exercise can help reduce your risk of developing type 2 diabetes in multiple ways.

Not only can it help you maintain a healthy weight, but it can also increase the body’s sensitivity to insulin, so it can be used more effectively – helping to keep blood sugar levels stable.

Plus, studies have shown that, alongside helping prevent diabetes, staying active may play a role in reversing it.

If you’d like to start taking small steps toward being more active, it’s worth reading our article: 17 creative ways to increase your daily step count. And, for more ideas and inspiration, head to our fitness and exercise section.

3. Get support to lose weight if you need it

The NHS recommends taking some steps towards losing weight if your BMI is 25 or above.

However, while we all know that eating a healthy diet and being active are good for us, losing weight can be easier said than done. So there’s nothing wrong with reaching out for support if you’re struggling to lose weight on your own.

One way you can do so is by joining a weight loss support group. If you’re looking for a place to start, the NHS has a lists several useful weight loss plans on their website. Your GP will also be able to advise you on the best ways to lose weight based on your individual health needs.

You could consider asking friends and family for help, too – perhaps by asking them to exercise with you and support you in making healthy meal choices.

4. Try to cut down on smoking

The risk of developing type 2 diabetes increases with the number of cigarettes you smoke. For example, one study showed that women who smoked more than 40 cigarettes a day were 74% more likely to develop diabetes, while men had a 45% increased risk. This is backed up by a 2018 population-based study that shows a link between cigarette smoking and pancreatic cell function.

Nicotine in cigarettes can make the body less sensitive to insulin, affecting how well it can use it. This causes both glucose and insulin levels to rise, which can develop into type 2 diabetes over time.

If you’re looking to give up smoking but are concerned about how you might do this, it’s worth chatting with your GP, who will be able to advise you based on your individual circumstances.

For more advice, check out our article: 7 tips for quitting smoking.

Final thoughts…

Considering our risk of developing certain health conditions can be daunting. However, it can be an important first step in making some positive lifestyle changes and taking control of our health.

If you’re aware that you need to make some lifestyle adjustments and are feeling overwhelmed, it can help to start small. Often, small changes come together to make a big difference and will be more sustainable in the long term.

It’s also key to be kind to yourself when working on your health, and give yourself credit for any positive changes you make, however small they might seem.

For more information, support, and advice, you can visit the Diabetes UK website. You might also like to read our article: 12 science-backed ways to lower (or regulate) blood sugar levels in our diet and nutrition section.

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I’m a diabetes doctor. This is how we drive down the disease

From telegraph.co.uk

Treating the condition is costing the NHS £1.5m an hour, but advances in technology, medication and diagnosis mean the future looks bright 

In the 20 years I’ve been caring for patients living with diabetes, the situation has spiralled. I remember diagnosing a 19-year-old with a complication of type 2 (T2) diabetes at the beginning of my career – it was so unusual that my team and I wrote it up as a case report.

When I was a medical student in the mid-1990s, approximately 1.4 million people in the UK were diagnosed with T2 diabetes. Today, 12 million people – that’s one in five adults in the UK – live with diabetes or prediabetes and these conditions are increasingly seen in teenagers and even younger children. A T2 diagnosis at 30 can shorten life expectancy by up to 14 years, and treating the condition is costing the NHS £1.5m an hour.

It’s not a coincidence that these figures have risen at an alarming rate at a time when ultra-processed foods now make up 57 per cent of calories consumed by adults in the UK. T2 diabetes and prediabetes (a condition of high blood sugar not yet severe enough to be diagnosed as T2 diabetes) has a clear association with diet, being overweight and more sedentary. Type 1 (T1) diabetes – an autoimmune disease in which the body destroys the cells in the pancreas that produce insulin – accounts for less than 10 per cent of cases and is not linked to lifestyle factors.

The statistics around T2 diabetes look daunting, but we can turn things around. Look at what we achieved with smoking-related lung cancer when we brought in bold public health measures and robust smoking legislation. With advances we’re seeing in technology, medication, and the timing of T2 diagnosis, the future of diabetes care is looking bright. This is why.

We’re testing insulin levels earlier

At the moment, the first time most people even think about T2 diabetes is when their GP tells them they have raised blood sugar, following a blood test known as HbA1c. The NHS over-40 health check includes this test, which reveals your blood glucose levels for the previous two or three months. It’s a good screening, but it doesn’t give you a completely clean bill of health. Even when your HbA1c result is within the reference range, you can’t tell how hard your pancreas is having to work to produce the hormone insulin to keep your blood sugar level normal.

As you become resistant to insulin, the pancreas has to ramp up insulin production to keep clearing enough sugar from the blood. I sometimes explain it to my patients like this: you might look at a racehorse and say: “My, that horse is galloping very fast. What an incredible animal,” but the jockey is having to go hell for leather to keep it moving. That jockey is your pancreas, trying to produce enough insulin to keep everything on track.

I often test my patients’ insulin level on a blood test if I’m worried about their metabolic health. I do think we will start testing insulin levels more widely, but until then, everyone should be aware of five key markers of insulin resistance, collectively known as metabolic syndrome (see box below), so they can take stock of their health. These markers are a warning light flashing on the dashboard that you may have insulin resistance. We need to take action at that point, and stop waiting for T2 to set in.

Simple things like eating a reduced-carb diet, fasting, minimising ultra-processed food and making sure you move your body every day can help reverse insulin resistance.

The tech in this space is sophisticated

Tech is already revolutionising the diabetes landscape. Continuous glucose monitors (CGM) – wearable sensors with a tiny detector filament that sits just under the skin to measure the glucose in the fluid surrounding your cells (known as interstitial fluid) which can be used to infer blood sugar levels – have totally transformed blood sugar monitoring for people with T1 diabetes. They’ve replaced numerous daily finger-prick blood tests with real-time data, and alerts that allow people to decide whether they need to eat something, or inject insulin.

In the past, my patients would have to very diligently keep a diary of their finger-prick results, but now they can just hand me their phone and I have weeks and weeks of data in front of me, all broken down into graphs and metrics.

By linking these monitors to a wearable insulin infusion pump, scientists have created a first-generation version of an “artificial pancreas”. The pancreas is an organ that’s about as long as your hand and found behind your stomach. One of its roles is to produce the hormone insulin, and it’s incredibly clever – it will release a tiny amount of insulin even if we are just thinking about food, in anticipation of us eating.

In diabetes, a person either lacks insulin (T1) or the body has become resistant or insensitive to insulin’s message (T2). In the later stages of T2, a person may have both insulin deficiency and insulin resistance.

An “artificial pancreas” for T1 diabetes combines a CGM which can now transmit its readings directly to an insulin infusion pump which then releases a precisely calculated dose to control an individual’s blood sugar. Some people with T1 diabetes are already using this technology, which still requires human input such as the amount of carbohydrate a person has eaten, whereas the next-generation versions are being developed to take this need for frequent human input out of the loop.

GLP-1s will get more efficient

For years, diabetes treatment has been very “glucocentric” – with an intense focus on bringing the blood sugar down. This is certainly very important, both in terms of your everyday health, and also preventing long-term complications such as kidney, nerve or sight damage. Now though, there are some brilliant drugs coming through.

It’s easy to forget GLP-1s were originally developed for the treatment of T2, mimicking glucagon-like peptide-1 (or GLP-1), a hormone that’s naturally released by the gut after eating and which tells the pancreas to release insulin and help blood glucose levels return to normal. But these drugs are now also showing clear benefits outside of glucose control, for example in reducing the risk for having a heart attack or stroke.

I predict that GLP-1s are going to become even more efficient, the side effects will lessen, most injectable versions will be replaced by tablets and as drugs fall out of patent and prices drop, they will become more accessible.

There’s also a triple-hormone injection, Retatrutide (or triple-G), which is currently being trialled with results suggesting it can lower blood sugar levels in people with T2 diabetes. It contains pharma versions of not just GLP-1 and glucose-dependent insulinotropic polypeptide (GIP), which are both in Mounjaro, but also the hormone glucagon, which plays a role in revving up metabolism.

Meanwhile, there are SGLT2 inhibitors which are bringing huge benefits to people with T2 diabetes. They work to lower blood sugar by making the kidneys urinate excess sugar. They are not a silver bullet, as sugary urine can cause some people to experience recurrent UTIs or genital thrush, but they hold huge promise.

We’re also seeing advances in treating the side effects of living with diabetes. Certain diabetes medications and particularly insulin can cause a “hypo” (short for hypoglycaemia, when the level of glucose in your blood drops below normal limits after taking too much insulin or missing a meal) and they are incredibly frightening.

Historically, they’ve been treated with sweet food or gels to get the blood glucose up very quickly. But that doesn’t help with the “hypo hangover” – where, even after the blood glucose readings are back to normal, brain fog persists as it takes the brain a while to efficiently use glucose as a fuel. Hypo treatment drink Klario, a new product, contains glucose to raise blood sugar as well as an alternative ketone-based fuel source that the brain can use.

We can drive diabetes down and it’s vital we do

The T2 landscape has become unrecognisable in the 30 years since I was a medical student, and if we fast forward another three decades from here, there’s no reason to believe it won’t have transformed once more – but for the better.

Back in the late 1950s, when as many as 70 per cent of men smoked, it might have been inconceivable to imagine a world where people weren’t allowed to smoke in offices, hospitals, pubs, on trains and planes. But it has happened, and with it cases of lung cancer in men have fallen by almost 40 per cent since the early 1990s.

I believe we could find a world where supermarkets label UPFs with health warnings and they become highly taxed, just as cigarettes are now. I think incorporating movement into our days will start to be taken very seriously by schools and employers, and metabolic testing will be standard for anyone with any of the five signs of insulin resistance, from an increased waist size to high blood pressure.

It’s bold, but it’s vital, because we can’t be in a situation where we allow insulin resistance to become the norm. The message I reinforce with my patients who have prediabetes and T2 – particularly early on in the illness – is that this is a reversible condition. You really can stop it yourself through your lifestyle. And once insulin resistance melts away, and your body’s cells start hearing insulin again, good health will be yours.

As told to Amy Packer

Dr Saira Hameed is a consultant endocrinologist at Imperial College Healthcare NHS Trust and a senior tutor and honorary clinical senior lecturer at Imperial College London. She holds a PhD in neuroendocrinology. Her new book, Signals, The Inside Story of our Hormones (£20; Faber) is out now

https://www.telegraph.co.uk/health-fitness/conditions/diabetes/diabetes-doctor-how-to-drive-condition-down/https://www.telegraph.co.uk/health-fitness/conditions/diabetes/diabetes-doctor-how-to-drive-condition-down/